Formulir Surat Izin Pengabdian
Format : ........./ LPPM-STKIPAM /SPD/Bulan (Romawi)/Tahun
Contoh : 01/LPPM-STKIPAM/SPD/XI/2017
Nomor Surat izin Pengabdian *
Your answer
Tanggal Surat *
MM
/
DD
/
YYYY
Lokasi Pengabdian *
Your answer
Nama Ketua (Lengkap dgn Gelar) *
Your answer
NIDN Ketua *
Your answer
Status Pengabdi 1 *
Program Studi *
Nama Anggota 1 (Lengkap dgn Gelar)
Your answer
NIDN Anggota 1
Your answer
Status Pengabdi 2
Program Studi
Nama Anggota 2 (Lengkap dgn Gelar)
Your answer
NIDN Anggota 2
Your answer
Status Pengabdi 3
Program Studi
Judul Pengabdian *
Your answer
Jadwal Pengabdian (Mulai) *
MM
/
DD
/
YYYY
Jadwal Pengabdian (Akhir) *
MM
/
DD
/
YYYY
Email *
Your answer
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